Oesophageal Cancer.-improving outcomes.

Anil Kaul

Consultant General and Upper GI SurgerySt Helens and Knowsley Teaching Hospitals NHS Trust

How big is the problem

• Oesophageal and Gastric cancer - 13500 patients affected each year in the UK

• Fifth most common malignancy• Fourth most common cause of death

• Oesophageal (numbers are rising)• Gastric (numbers are decreasing)• OG Junction ( numbers are rising)

Oesophageal cancer

• 13th most common cancer in the UK• Total cases 8332• Males 5582 (67%)• Females 2750 (35%)

• Higher incidence in the northwest• Expected number about 110 cases in 2 years• Actual numbers about 190 cases in 2 years

Risk factors

• Age >55• Male• Deprivation• Tobacco• Alcohol• Obesity• H Pylori• Reflux

Symptoms SIGN 2006 ;NICE 2004

• Dysphagia• Odynophagia• Persistent dyspepsia.• Loss of Appetite• Loss of weight• Vomiting• GI Blood Loss, Anaemia, Malaena, Haematemesis

Be clear on cancer campaign

• heartburn most days for 3 weeks or more. • indigestion on and off for 3 weeks or more • food feels like it’s sticking in your throat when you swallow • losing weight for no obvious reason • Trapped wind and frequent burping • Feeling full very quickly when eating • Feeling bloated after eating • Nausea or vomiting

• Stomach pain

How do I reduce my chances of getting this cancer ?

• Stop smoking

• Look after yourself, If you’re overweight, you

should lose weight

• Eat healthily, Try to get your 5 A DAY

• Cut back on drinking alcohol

Investigations

• For Diagnosis• Endoscopy• Barium Swallow and Meal

• For Staging• CT/ EUS/PET• Staging Laparoscopy

Treatment Options

• Curative• Surgery• Chemotherapy• Radiotherapy

• Palliative• Chemotherapy• Radiotherapy• Stent

Outcomes

• Oesophageal• Overall 5 year survival 7 % (AUGIS 2012)

• Gastric• Overall 5 year survival 13% (AUGIS 2012)

The need for action

• In St Helens and Knowsley the incidence is higher

than national average

• Patients are diagnosed at a later stage in the disease

• Overall outcome compared to the national average is

poor

NAEDI National Awareness and early Diagnosis Initiative

• 950 deaths from Oesophago gastric cancer can be avoided each year (CRUK) if our results were as good as Europe

• Main Factor Identified is delay in diagnosis

Results

• Results of curative Treatments are similar to the rest of the UK and Europe

• Cancer Research UK / DOH has identified late presentation as the main reason for poor outcome

Bottom line

• Prevention

• Early diagnosis

• Curative treatment

Early Diagnosis is the key

• Who diagnoses them

• GP 63.3 %• AED 16.4%• Other specialties 17.3%

• GP suspected cancer 68.8%

• Overall only 45.6 % diagnosed because GP suspected cancer

So what’s the cause of delay

• Patient related» Ignorance iVan»Fear»Access to services

• Primary Care related»? Support / ? resource

• Secondary care» Inefficient System

Way forward- Collaboration - MCCN – “How to save an extra 424 lives ….. Catching cancer

earlier”

• Primary Care ownership of this issue

• Partnership working with Public Health and Secondary Care.

NAEDINational Awareness and early Diagnosis Initiative

• Achieve Early Presentation

• Optimise Clinical Practice

• Improve GP Access to Diagnostic test

• Research Evaluate and Monitor